• Kathryn Levy, Pei C Grant, Kelley Clem, Danielle S Eadie, and Jonathan L Rossi.
• Research Department, Hospice and Palliative Care Buffalo, Cheektowaga, New York, USA.
• J Palliat Med. 2021 Aug 1; 24 (8): 1139-1146.

AbstractBackground: Interpersonal hurt or offenses are common human experiences. Bereavement may be impacted for caregivers of a terminally ill loved one when these experiences occur. Objective: To determine the prevalence and impact of interpersonal hurt-based experiences for hospice caregivers and interest in forgiveness-based support. Design: Cross-sectional, mixed methods needs assessment. Settings/Subjects: Bereaved hospice caregivers (n = 162) and direct care hospice clinicians (n = 133) were surveyed through mail-in and online surveys. Measurements: Participants completed ad hoc surveys to assess prevalence and impact of interpersonal hurt experiences and interest in forgiveness-based support. Bereaved caregivers also completed the Core Bereavement Items (CBI). Results: 41.98% of the bereaved experienced an interpersonal hurt or offense during the care or passing of their loved one. Those with hurt experiences felt highly impacted (63.2%), "sometimes" or "often" revisited the experience (91.2%), felt that their bereavement was affected (61.5%), and experienced physical symptoms (46.3%). CBI scores positively correlated with the impact of the experience. Hurt caregivers had higher CBI scores compared with those who did not. Of those who had not forgiven the offender, 46.3% felt that they could benefit from forgiveness-based support services. Qualitative analysis revealed themes of Disagreements with Decisions, Lack of Support, Relational Interactions, and Impact on Bereavement. Clinician responses supported these results. Conclusions: Interpersonal hurt experiences can greatly impact the offended caregiver during caregiving and in bereavement. However, it should be noted that the decision to forgive is ultimately a personal choice and therefore forgiveness-based for forgiveness-specific interventions may not be appropriate for all individuals. Future research should assess the feasibility and usefulness of this type of support for caregivers and the bereaved.

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